zdorПроблемы здоровья и экологииHealth and Ecology Issues2220-09672708-6011Gomel State Medical University10.51523/2708-6011.2023-20-4-08zdor-2648Research ArticleКЛИНИЧЕСКАЯ МЕДИЦИНАCLINICAL MEDICINEКлиническая характеристика и оценка частоты осложнений после оперативного лечения пациентов со свободными и ущемленными грыжами с применением синтетических имплантатовClinical characteristics and assessment of the frequency of complications after surgical treatment of patients with free and strangulated hernias using synthetic implantshttps://orcid.org/0000-0003-0639-121XЛызиковА. А.LyzikovA. A.

Лызиков Алексей Анатольевич, д.м.н., профессор, сосудистый и эндоваскулярный хирург

Бредфорд

Alexei A. Lyzikov, Doctor of Medical Sciences, Professor, Vascular Surgeon

Bradford

https://orcid.org/0000-0001-5493-0164АртюшковЕ. Л.ArtyushkovE. L.

Артюшков Евгений Леонидович, ассистент кафедры хирургических болезней № 1 с курсом сердечно-сосудистой хирургии

Гомель

Evgeniy L. Artyushkov, Assistant Lecturer at the Department of Surgical Diseases No.1 with the Course of Cardiovascular Surgery

Gomel

https://orcid.org/0000-0001-5395-5044ДорошкоЕ. Ю.DoroshkoYa. Y.

Дорошко Евгений Юрьевич, к.м.н. ассистент кафедры хирургических болезней № 1 с курсом сердечно-сосудистой хирургии

Гомель

Yauheni Y. Doroshko, Candidate of Medical Sciences, Assistant Lecturer at Department of Surgical Diseases No.1 with the Course of Cardiovascular Surgery

Gomel

https://orcid.org/0000-0001-7782-3281КапланМ. Л.KaplanM. L.

Каплан Марк Львович, к.м.н., доцент, заведующий кафедрой хирургических болезней № 1 с курсом сердечно-сосудистой хирургии

Гомель

Mark L. Kaplan, Candidate of Medical Sciences, Head of the Department of Surgical Diseases No.1 with the Course of Cardiovascular Surgery

Gomel

Университетская клиника Бредфордского университетаBradford Teaching HospitalГомельский государственный медицинский университетGomel State Medical University20230501202420463–69Copyright © Лызиков А.А., Артюшков Е.Л., Дорошко Е.Ю., Каплан М.Л., 20242024Лызиков А.А., Артюшков Е.Л., Дорошко Е.Ю., Каплан М.Л.Lyzikov A.A., Artyushkov E.L., Doroshko Y.Y., Kaplan M.L.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.gsmu.by/jour/article/view/2648

Цель исследования. Дать клиническую оценку и провести сравнительный анализ частоты послеоперационных осложнений у пациентов со свободными и ущемленными грыжами различных локализаций после ненатяжной герниопластики с применением синтетических имплантатов.Материалы и методы. Проведен ретроспективный анализ 965 медицинских карт стационарных пациентов, которым в плановом и экстренном порядке выполнялись ненатяжные герниопластики при грыжах различных локализаций в период с 2018 по 2022 г. Обработку результатов исследования проводили методами прикладной статистики с использованием MS Excel и программного пакета для статистического анализа «Statistica», 10.0. Статистически значимыми считались различия при р < 0,05.Результаты. В исследовании было выявлено, что в послеоперационном периоде после ненатяжной герниопластики у пациентов с ущемленными грыжами частота осложнений составила 15,8 %. При этом частота осложнений была больше после герниопластики по «onlay» у пациентов с ущемленными грыжами, чем у пациентов со свободными грыжами. Частота послеоперационных осложнений у пациентов с ущемленными послеоперационными вентральными грыжами в 8,3 раза выше, чем у пациентов со свободными послеоперационными вентральными грыжами. В послеоперационном периоде у пациентов с ущемленными грыжами выявлены такие осложнения, как серома и инфильтрат послеоперационной раны в 10,5 и 5,2 % случаев. Продолжительность стационарного лечения пациентов с осложнениями после герниопластики в 2,6 раза больше в сравнении с пациентами без осложнений (р < 0,05).Заключение. В послеоперационном периоде у пациентов с ущемленными грыжами частота осложнений наблюдалась в 15,8 % случаев, а у пациентов со свободными и невправимыми грыжами — в 1,5 % случаев. Клинически были выявлены такие послеоперационные осложнения, как серомы, инфильтраты послеоперационной раны, лигатурные свищи, гематома мошонки, орхит, абсцесс послеоперационной раны.

Objective. To give a clinical assessment and conduct a comparative analysis of the frequency of postoperative complications in patients with free and strangulated hernias of various localizations after tension-free hernioplasty using synthetic implants.Materials and methods. A retrospective analysis of 965 medical records of inpatient patients who underwent tension-free hernioplasty for hernias of various localizations in the period from 2018 to 2022 was carried out. The results of the study were processed using applied statistics using MS Excel and a software package for statistical analysis “Statistica v. 10.0”. Statistically significant differences were considered at p < 0.05.Results. The study revealed that in the postoperative period after tension-free hernioplasty in patients with strangulated hernias, the complication rate was 15.8%. At the same time, the frequency of complications was higher after “onlay” hernioplasty in patients with strangulated hernias than in patients with free hernias. The frequency of postoperative complications in patients with impaired postoperative ventral hernias is 8.3 times higher than in patients with free postoperative ventral hernias. In the postoperative period, complications such as seroma and infiltration of the postoperative wound were detected in 10.5 and 5.2% of cases in patients with strangulated hernias. The duration of inpatient treatment for patients with complications after hernioplasty is 2.6 times longer compared to patients without complications (p < 0,05).Conclusion. In the postoperative period, in patients with strangulated hernias, the incidence of complications was observed in 15.8% of cases, and in patients with free and irreducible hernias in 1.5% of cases. Clinically, such postoperative complications as seromas, infiltrates of the postoperative wound, ligature fistulas, scrotal hematoma, orchitis, abscess of the postoperative wound were identified.

ущемленные грыжираневые осложнениясинтетические протезыгерниопластикаstrangulated herniaswound complicationssynthetic prostheseshernioplastyReferencesЖуков Б.Н., Быстров С.А., Шестаков Е.В. Оптимизация хирургического лечения больных с ущемленной грыжей брюшной стенки. Хирургия. Журнал им. Н.И. Пирогова. 2014;(8):67-70. [дата обращения 2023 август 01]. Режим доступа: https://elibrary.ru/item.asp?id=22381338Zhukov BN, Bystrov SA, Shestakov EV. Optimization of surgical treatment of patients with restrained herhia of the abdominal wall. Surgery. Journal named after N.I. Pirogov. 2014;(8):67-70. [date of access 2023 august 01]. Available from: https://elibrary.ru/item.asp?id=22381338 (In Russ.).Иванов Ю.В., Панченков Д.Н., Афонина Н.С., Чугунов В.С. Медико-экономические подходы к выбору способа хирургического лечения паховых грыж в современных условиях страховой медицины. Вестник. экспериментальной и клинической хирургии. 2016;9(1):10-18. [дата обращения 2023 август 01]. Режим доступа: https://elibrary.ru/item. asp?id=27497612Ivanov YV, Panchenkov DN, Afonin NS, Chugunov VS. The Medical Economic Approaches to the Choice of Method of Surgical Treatment of Inguinal Hernias in Modern Conditions of Insurance Medicine. Vestnik of experimental and clinical surgery. 2016;9(1):10-18. (In Russ.). [date of access 2023 august 01]. Available from: https://elibrary.ru/item.asp?id=27497612 (In Russ.).Юрасов А.В., Абовян Л.А., Курашвили Д.Н., Лысенко М.В., Дубров В.Э. Отдаленные результаты оперативного лечения больных с пупочными грыжами и диастазом прямых мышц живота. Вестник экспериментальной и клинической хирургии. 2014;(4):309-314. [дата обращения 2023 август 01]. Режим доступа: https://elibrary.ru/item.asp?id=23435570Iurasov AV, Abovian LA, Kurashvil DN. Distant results of surgical treatment in patients with umbilical hernia and diastasis recti. Vestnik of experimental and clinical surgery. 2014;(4):309–314 (In Russ.). [date of access 2023 august 01]. Available from: https://elibrary.ru/item.asp?id=23435570 (In Russ.).Юрасов А.В., Шестаков А.Л., Курашвили Д.Н., Абовян Л.А. Современная концепция хирургического лечения больных с послеоперационными грыжами передней брюшной стенки. Вестник экспериментальной и клинической хирургии. 2014;(7):405-413. [дата обращения 2023 август 01]. Режим доступа: https://elibrary.ru/item.asp?id=23435585Iurasov AV, Shestakov AL, Kurashvil DN, Abovian LA. The modern concept of surgical treatment of patients with postoperative hernias of the anterior abdominal wall. Vestnik of experimental and clinical surgery. 2014;(7):405-413. [date of access 2023 august 01]. Available from: https://elibrary.ru/item.asp?id=23435585 (In Russ.).Alvarez J, Baldonedo R, Bear I, Solis J, Alvarez P, JorgeBessa S, Abdel-Razek A. Results of prosthetic mesh repair in the emergency management of the acutely incarcerated and/or strangulated ventral hernias: a 7 years study. Hernia. 2013;(17):59-65. DOI: https://doi.org/10.1007/s10029-012-0938-xAlvarez J, Baldonedo R, Bear I, Solis J, Alvarez P, JorgeBessa S, Abdel-Razek A. Results of prosthetic mesh repair in the emergency management of the acutely incarcerated and/or strangulated ventral hernias: a 7 years study. Hernia. 2013;(17):59-65. DOI: https://doi.org/10.1007/s10029-012-0938-xAndersen L, Klein M, Ggenur I, Rosenberg J. Longterm recurrence and complication rates after incisional hernia repair with the open onlay technique. BMC Surgery. 2009;(9):6. DOI: https://doi.org/10.1186/1471248296Andersen L, Klein M, Ggenur I, Rosenberg J. Longterm recurrence and complication rates after incisional hernia repair with the open onlay technique. BMC Surgery. 2009;(9):6. DOI: https://doi.org/10.1186/1471248296Bessa S, Abdel-Razek A. Results of prosthetic mesh repair in the emergency management of the acutely incarcerated and/or strangulated ventral hernias: a 7 years study. Hernia. 2013;17(1):59-65. DOI: https://doi.org/10.1007/s10029-012-0938-xBessa S, Abdel-Razek A. Results of prosthetic mesh repair in the emergency management of the acutely incarcerated and/or strangulated ventral hernias: a 7 years study. Hernia. 2013;17(1):59-65. DOI: https://doi.org/10.1007/s10029-012-0938-xBliziotis I, Kasiakou S, Kapaskelis A, Falagas M. Meshrelated infection after hernia repair: case report of an emerging type of foreign-body related infection. Infection. 2006;34(1):46-48. DOI: https://doi.org/10.1007/s15010-006-4140-xBliziotis I, Kasiakou S, Kapaskelis A, Falagas M. Meshrelated infection after hernia repair: case report of an emerging type of foreign-body related infection. Infection. 2006;34(1):46-48. DOI: https://doi.org/10.1007/s15010-006-4140-xBurger J, Luijendijk R, Hop W, Halm J, Verdaasdonk E, Jeekel J. Long-term follow-up of a randomized controlled trial of suture versus mesh repair of incisional hernia. Annals of surgery. 2004;240(4):578-83. DOI: https://doi.org/10.1097/01.sla.0000141193.08524.e7Burger J, Luijendijk R, Hop W, Halm J, Verdaasdonk E, Jeekel J. Long-term follow-up of a randomized controlled trial of suture versus mesh repair of incisional hernia. Annals of surgery. 2004;240(4):578-83. DOI: https://doi.org/10.1097/01.sla.0000141193.08524.e7Choi J, Palaniappa N, Dallas K. Use of mesh during ventral hernia repair in clean-contaminated and contaminated cases: outcomes of 33,832 cases. Annals of surgery. 2012;(255):176-180. DOI: https://doi.org/10.1097/SLA.0b013e31822518e6Choi J, Palaniappa N, Dallas K. Use of mesh during ventral hernia repair in clean-contaminated and contaminated cases: outcomes of 33,832 cases. Annals of surgery. 2012;(255):176-180. DOI: https://doi.org/10.1097/SLA.0b013e31822518e6Cobb W, Harris J, Lokey J, McGill E, Klove K. Incisional herniorrhaphy with intraperitoneal composite mesh: a report of 95 cases. The American surgeon. 2003;69(9):784-788. [date of access 2023 august 01]. Available from: https://pubmed.ncbi.nlm.nih.gov/14509327Cobb W, Harris J, Lokey J, McGill E, Klove K. Incisional herniorrhaphy with intraperitoneal composite mesh: a report of 95 cases. The American surgeon. 2003;69(9):784-788. [date of access 2023 august 01]. Available from: https://pubmed.ncbi.nlm.nih.gov/14509327Diaz-Godoy A, Garcia-Urena M, Lopez-Monclus J. Searching for the best polypropylene mesh to be used in bowel contamination. Hernia. 2011;(15):173-179. DOI: https://doi.org/10.1007/s10029-010-0762-0Diaz-Godoy A, Garcia-Urena M, Lopez-Monclus J. Searching for the best polypropylene mesh to be used in bowel contamination. Hernia. 2011;(15):173-179. DOI: https://doi.org/10.1007/s10029-010-0762-0Falagas M, Kasiakou S. Mesh-related infections after hernia repair surgery. Clinical microbiology and infection. 2005;11(1):3-8. DOI: https://doi.org/10.1111/j.1469-0691.2004.01014.xFalagas M, Kasiakou S. Mesh-related infections after hernia repair surgery. Clinical microbiology and infection. 2005;11(1):3-8. DOI: https://doi.org/10.1111/j.1469-0691.2004.01014.xLanger C, Liersch T, Kley C, Flosman M, Süss M, Siemer A, Becker H. Twenty-five years of experience in incisional hernia surgery. A comparative retrospective study of 432 incisional hernia repairs. Chirurg. 2003;74(7):638-645. DOI: https://doi. org/10.1007/s00104-002-0594-2Langer C, Liersch T, Kley C, Flosman M, Süss M, Siemer A, Becker H. Twenty-five years of experience in incisional hernia surgery. A comparative retrospective study of 432 incisional hernia repairs. Chirurg. 2003;74(7):638-645. DOI: https://doi. org/10.1007/s00104-002-0594-2Mazaki T, Mado K, Masuda H, Shiono M, Tochikura N, Kaburagi M. A randomized trial of antibiotic prophylaxis for the prevention of surgical site infection after open mesh-plug hernia repair. American journal of surgery. 2014;207(4):476-484. DOI: https://doi.org/10.1016/j.amjsurg.2013.01.047Mazaki T, Mado K, Masuda H, Shiono M, Tochikura N, Kaburagi M. A randomized trial of antibiotic prophylaxis for the prevention of surgical site infection after open mesh-plug hernia repair. American journal of surgery. 2014;207(4):476-484. DOI: https://doi.org/10.1016/j.amjsurg.2013.01.047Napolitano L, Di Bartolomeo N, Aceto L, Waku М, Innocenti P. Use of prosthetic materials in incisional hernias: our сlinical experience. Il Giornale di chirurgia. 2004;25(4):141-145. [date of access 2023 august 01]. Available from: https://pubmed. ncbi.nlm.nih.gov/15283407Napolitano L, Di Bartolomeo N, Aceto L, Waku М, Innocenti P. Use of prosthetic materials in incisional hernias: our сlinical experience. Il Giornale di chirurgia. 2004;25(4):141-145. [date of access 2023 august 01]. Available from: https://pubmed. ncbi.nlm.nih.gov/15283407Polcz M, Pierce R, Olson M, Blankush J, Duke M, Broucek J, Bradley 3rd J. Outcomes of light and midweight synthetic mesh use in clean-contaminated and contaminated ventral incisional hernia repair: an ACHQC comparative analysis. Surgical endoscopy. 2022;(37):5583-5590. DOI: https://doi.org/10.1007/s00464-022-09739-0Polcz M, Pierce R, Olson M, Blankush J, Duke M, Broucek J, Bradley 3rd J. Outcomes of light and midweight synthetic mesh use in clean-contaminated and contaminated ventral incisional hernia repair: an ACHQC comparative analysis. Surgical endoscopy. 2022;(37):5583-5590. DOI: https://doi.org/10.1007/s00464-022-09739-0San Miguel C, Melero D, Jiménez E, López P, Robin Á, Blázquez L, López-Monclús J, González E, Jiménez C, GarcíaUreña M. Long-term outcomes after prophylactic use of onlay mesh in midline laparotomy. Hernia. 2018;22(6):1113-1122. DOI: https://doi.org/10.1007/s10029-018-1833-xSan Miguel C, Melero D, Jiménez E, López P, Robin Á, Blázquez L, López-Monclús J, González E, Jiménez C, GarcíaUreña M. Long-term outcomes after prophylactic use of onlay mesh in midline laparotomy. Hernia. 2018;22(6):1113-1122. DOI: https://doi.org/10.1007/s10029-018-1833-xSanchez V, Abi-Haidar Y, Itani K. Mesh infection in ventral incisional hernia repair: incidence, contributing factors, and treatment. Surgical infections. 2011;12(3):205-210. DOI: https://doi.org/10.1089/sur.2011.033Sanchez V, Abi-Haidar Y, Itani K. Mesh infection in ventral incisional hernia repair: incidence, contributing factors, and treatment. Surgical infections. 2011;12(3):205-210. DOI: https://doi.org/10.1089/sur.2011.033Stremitzer S, Bachleitner-Hofmann T, Gradl B, Gruenbeck M, Bachleitner-Hofmann B, Mittlboeck M, Bergmann M. Mesh graft infection following abdominal hernia repair: risk factor evaluation and strategies of mesh graft preservation. A retrospective analysis of 476 operations. World journal of surgery. 2010;(34):1702-1709. DOI: https://doi.org/10.1007/s00268-010-0543-zStremitzer S, Bachleitner-Hofmann T, Gradl B, Gruenbeck M, Bachleitner-Hofmann B, Mittlboeck M, Bergmann M. Mesh graft infection following abdominal hernia repair: risk factor evaluation and strategies of mesh graft preservation. A retrospective analysis of 476 operations. World journal of surgery. 2010;(34):1702-1709. DOI: https://doi.org/10.1007/s00268-010-0543-zYabanoğlu H, Arer İ, Çalıskan K. The Effect of the Use of Synthetic Mesh Soaked in Antibiotic Solution on the Rate of Graft Infection in Ventral Hernias: A Prospective Randomized Study. International surgery. 2015;100(6):1040-1047. DOI: https://doi.org/10.9738/INTSURG-D-14-00304.1Yabanoğlu H, Arer İ, Çalıskan K. The Effect of the Use of Synthetic Mesh Soaked in Antibiotic Solution on the Rate of Graft Infection in Ventral Hernias: A Prospective Randomized Study. International surgery. 2015;100(6):1040-1047. DOI: https://doi.org/10.9738/INTSURG-D-14-00304.1Zafar H, Zaidi M, Qadir I, Memon A. Emergency incisional hernia repair: a difficult problem waiting for a solution. Annals of surgical innovation and research. 2012;6(1):1. DOI: https://doi.org/10.1186/1750-1164-6-1Zafar H, Zaidi M, Qadir I, Memon A. Emergency incisional hernia repair: a difficult problem waiting for a solution. Annals of surgical innovation and research. 2012;6(1):1. DOI: https://doi.org/10.1186/1750-1164-6-1Zhu L, Schuster P, Klinge U. Mesh implants: An overview of crucial mesh parameters. World J Gastrointest Surg. 2015;7(10):226-236. DOI: https://doi.org/10.4240/wjgs.v7.i10.226Zhu L, Schuster P, Klinge U. Mesh implants: An overview of crucial mesh parameters. World J Gastrointest Surg. 2015;7(10):226-236. DOI: https://doi.org/10.4240/wjgs.v7.i10.226

The authors declare that there are no conflicts of interest present.